Individual
ANASTASIA KATRINA MARISA DEFORGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
115 CARRIE REX AVE, MELBA, ID 83641-5187
(702) 768-8875
Mailing address
115 CARRIE REX AVE, MELBA, ID 83641-5187
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
ID
Other
Enumeration date
07/09/2026
Last updated
07/09/2026
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